Radiotherapy-related fibrosis remains one of the most challenging treatment related side effects encountered by patients with head and neck cancer. Several established and ongoing novel therapies ...have been studied with paucity of data in how to best treat these patients. This review aims to provide researchers and health care providers with a comprehensive review on the presentation, etiology, and therapeutic options for this serious condition.
Many institutions worldwide currently deliver left breast radiotherapy in free breathing mode, mostly due to the unavailability of a Deep Inspiration Breath Hold technique (DIBH). This study aims at ...quantifying the error in dose delivery (compared to treatment plan) due to respiratory motion in free breathing irradiation of left breast or chest wall. Since subfields often consist in small, fine-tuned, highly targeted fields, slight intrafractional target motion may compromise their subtle benefit. Thus we analyzed the respiratory motion effect on target dose coverage, dose homogeneity and left lung dose.
Treatment plans for twenty left breast or chest wall cancer patients previously treated at our center were retrieved and retrospectively planned with the introduction of an appropriate shift in isocenter location to simulate free breathing target motion.
No clinically significant dosimetric changes were found in all twenty cases when breathing motion was accounted for. Changes in target dose coverage (V95%), in target maximum dose (D2%) and in V20Gy lung dose were respectively less than 1.5%, 0.3% and 2.6%.
The findings suggest that breast irradiation in free breathing mode does not undermine the dosimetric merits of the field-in-field technique and does not produce clinically significant dosimetric differences in dose delivery for target and lung compared to plan.
•Breathing has a negligible effect on dose delivery accuracy in breast cancer radiotherapy.•Free breathing during breast radiotherapy treatment does not invalidate the use of field-in-field technique.•The dosimetric error from free breathing breast motion during radiotherapy treatment is clinically negligible.
•Preoperative single-fraction partial breast irradiation is a safe and feasible treatment for elderly patients with low-risk early-stage breast cancer.•The risk of recurrence is low in single ...fraction pre-operative breast radiation therapy.•Preoperative single-fraction partial breast irradiation is associated with very low rates of surgical complications and of acute and late radiation toxicity, as well as high rates of excellent cosmetic outcome.
Preoperative partial breast irradiation (PBI) is a novel technique that can be used in patients with early-stage breast cancer with the goal of limiting the irradiated breast volume, toxicity and number of fractions. The aim of this trial is to assess the toxicity, surgical, oncologic and cosmetic outcomes of preoperative PBI.
In this single-arm phase II trial, we enrolled women ≥ 60 years, with unifocal low-risk breast invasive ductal carcinoma (cT1N0, grade 1–2, ER+, Her2-). Patients were treated with a single fraction of 20 Gy of preoperative PBI using volumetric modulated arc therapy (VMAT). Patients then underwent breast-conserving surgery (BCS) +/- sentinel lymph node biopsy within 72 h of radiation. Primary outcomes were rate of surgical complications and early toxicity. Secondary outcomes were cosmesis at 12 months, chronic toxicity and ipsilateral breast tumor recurrence.
Twenty-five patients were recruited with a median age of 67 years, and a median follow-up of 60 months. Sentinel biopsy was positive in 1 out of 24 patients (4 %). Two patients received adjuvant RT for close margins or positive lymph nodes. Within the first 90 days, none of the patients had surgical complications; almost all had grade 0 to 1 acute and late RTOG skin toxicity. The cosmetic outcome was rated between good and excellent in all cases by physicians and patients, except for one patient who self-rated her cosmesis as fair as of the third year. There were no recurrences.
Preoperative single-fraction PBI is a safe and feasible treatment for elderly patients with low-risk early-stage breast cancer, with no surgical complications, very low rates of acute and late radiation toxicity, and excellent cosmetic outcomes. Randomized controlled trials are needed to compare preoperative to adjuvant PBI in this patient population.
•Single-fraction partial breast irradiation, followed by surgery after 3 months, leads to a high rate of pathologic response.•A single dose of 20 Gy to the breast tumor is acutely well tolerated.•The ...3-month preoperative interval is suboptimal for late toxicities and cosmesis.
A novel approach using single-fraction preoperative partial breast irradiation (PBI) for low-risk breast cancer is under study. We sought to investigate the rate of pathologic response (pR), toxicities and cosmetic results related to this new treatment strategy.
Women of 65 years or older with stage I unifocal luminal A breast cancer were eligible for inclusion in this phase I prospective trial. Patients received a single 20 Gy dose of PBI followed by breast-conserving surgery (BCS) 3 months later. The primary endpoint was the pR rate, and the secondary endpoints were radiation therapy-related toxicity and cosmetic results.
Thirteen patients were treated, with a median age of 71. Eleven patients (84.6 %) had pR with a median residual cellularity of 1 % (range: 0–10 %). At median follow-up of 48.5 months, no recurrences or cancer-related deaths were recorded. Acute radiation therapy-related toxicity were limited to grade 1 dermatitis and breast pain. At the 1-year follow-up, there were one grade 2 fat necrosis and two grade 3 toxicities (wound infection and hematoma). Only grade 1 toxicities remained at 2 years, but one grade 2 toxicity (fibrosis/induration) developed by the 3-year follow-up. Three-year patient-reported cosmetic outcomes were good or excellent in 60 % of patients.
Single-fraction preoperative PBI preceding BCS for low-risk breast cancer is feasible, relatively well tolerated and leads to a high level of pR. The 3-month interval after PBI seems to place surgery in a post-radiation inflammatory phase. Further delay between PBI and surgery could improve pR and cosmetic outcome. NCT03917498.
Recommender systems can guide the users in a tailored way to interesting objects in a large space of possible options. The Content-based Filtering (CBF) approach is one of the most widely adapted to ...date. It analyses a set of textual descriptions of items. These items are already evaluated by an interactive user in prior steps. It then builds a model or profile of this user. The profile is then exploited to suggest a new item. Unfortunately, filtering in this method is mainly used for recommending only one item at a time. The research here considers how this component can propose a list of items to a user from large amounts of data. We enhance the Content-based Filtering algorithm in order to explore a huge data set and return a list of recommendations rather than just rating an item. For this, an Artificial Bee Colony (ABC) technique has been adapted and applied to the CBF method. ABC is one of the efficient Evolutionary Computing techniques that are used in solving optimization problems.
•High performance concrete mixtures incorporating up to 40% ceramic waste powder as large partial replacement of cement can be produced.•High performance concrete mixture incorporating large content ...of ceramic waste powder showed high strength and excellent durability performance.•Ceramic waste powder acts primarily as a filler rather than pozzolanic material.•Producing high performance concrete can be an excellent source for recylcing large quantities of ceramic waste powder.
Ceramic waste powder (CWP) is produced during ceramic tile polishing with potential environmental pollution. CWP is silica-rich, alumina-rich and fine particle size material. High performance concrete (HPC) mixtures incorporating 10–40% CWP as replacement of Portland cement by mass were evaluated. Mechanical, durability and microstructural investigations of HPC mixtures were performed. It is shown that concrete incorporating CWP as large replacement of cement has high strength and excellent durability. Microstructure investigations showed that incorporating CWP did not make significant difference in cement hydration compared with cement without CWP. Performance improvement is explained by the low water/cement ratio of the reference mixture enabling CWP to create dense packing particles.
Conjugating drugs with gold nanoparticles (GNP) is a key strategy in cancer therapy. Herein, the potential inhibition of the phosphatidylinositol 3-kinase (PI3K)/Akt pathway, and other pathways of ...the MCF-7 cell-line, was investigated upon treatment with gold nanorods (GNR) conjugated with a PI3K inhibitor drug. The results revealed that the coupling of GNR with the drug drastically modulated the expression of PI3Kα at the gene and protein levels compared to the drug or GNR alone. The PI3Kα pathway is involved in tumor progression and development through the mediation of different mechanisms such as apoptosis, proliferation, and DNA damage. Treatment with the nanocomplex significantly affected the gene expression of several transcription factors responsible for cell growth and proliferation, apoptotic pathways, and cell cycle arrest. Furthermore, the gene expression of different regulatory proteins involved in cancer progression and immune responses were significantly modified upon treatment with the nanocomplex compared to the free drug or GNR alone.
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